States Relax Medicaid Eligibility for Former Foster Kids

One of the most publicized and popular change under the Affordable Care Act allows young people to stay under their parents' health-care plans until they turn 26. Thanks to a lesser-known provision in the same law, a handful of states are working hard to make sure foster kids know they are eligible for the same benefit.

Under the 2010 federal health law, individuals who were in a state's foster care system when they turned 18 qualify for Medicaid until the month of their 26th birthday -- but only if they still live in the state where they were in foster care. To avoid punishing people for pursuing out-of-state employment or education opportunities after 18, 11 states have taken the additional step of extending Medicaid to former foster care youth who lived in another state at the time they were in the child welfare system. Several advocacy organizations, such as such as the Center for Law and Social Policy and First Focus, say the federal foster care provision alone may be too narrow and recommend that states include former foster care youths from other states.

"They should get the same rights that anyone else does who lives in this state," says California Sen. Ed Hernandez, who co-sponsored a Medicaid expansion bill last year that gives young people who matriculated from a foster care system outside California access to Medicaid. (Georgia, Kentucky, Louisiana, Massachusetts, Minnesota, Montana, New York, Pennsylvania, South Dakota and Wisconsin have also extended Medicaid to former foster care youths, regardless of state residency.)

Before the Affordable Care Act (ACA), more than a quarter of Americans aged 18 to 26 did not have health insurance. Now, under the foster care provision, the number of people in that group eligible for Medicaid will grow from 55,000 this year to 74,000 in 2017, according to actuarial estimates by the Centers for Medicare and Medicaid Services.

That's a small number of people, relative to other newly eligible groups -- such as near-poor childless adults -- who stand to receive public health insurance under the 2010 law. Nonetheless, access to health care is especially important for alumni of state foster care systems because the evidence suggests that they suffer disproportionate rates of physical ailments, such as asthma, dental decay and malnutrition. They also develop a dependency on drugs at higher rates than their peers. Within the Medicaid program, claims data show that as many as 57 percent of youth in foster care meet criteria for a mental disorder.

"Since the coverage afforded under ACA is still relatively new, we have yet to hear about how former foster youth are using it," says Shadi Houshyar, vice president of child welfare policy at First Focus, a national children's advocacy group. Because of the documented health needs of former foster youth, though, Houshyar says Medicaid may mean better access to dental care, prescription medications for mental illness, and services related to substance abuse, such as counseling and treatment. And supporters of the foster care provision argue that extending health care to these young adults actually helps the community at large by keeping these individuals out of crises that might lead to hospitalizations and emergency room visits.

State welfare agencies have tapped local nonprofits to help them in engaging young people who could receive Medicaid under the ACA's foster care provision. In Maryland, for example, Advocates for Children and Youth, a research and advocacy nonprofit, has designed pocket-size brochures and produced short web videos about the provision that can be shared on social media. In California, Children Now, a children's education and health advocacy nonprofit, launched a public information campaign called Coveredtil26, along with a website dedicated to the Medicaid provision for former foster care youth.

A majority of states already have some experience expanding Medicaid coverage for foster care alumni. Under a federal law passed in 1999, 30 states took advantage of a voluntary measure called the Chafee Option, which allowed former foster care youth to retain Medicaid coverage until age 21. In a 2012 study of 10 states by the Urban Institute, researchers found that participation was higher in places that sought to make enrollment or recertification as simple and automatic as possible.

"The more work you make youth do, the less they're going to do it," says Dina Emam, a research associate at the Urban Institute. States that required young adults to fill out paperwork and visit multiple government offices in person saw lower take-up rates. Based on that study, Emam recommends that states automatically enroll foster care youth into Medicaid when they turn 18. When a young person does have to sign up, the Urban Institute recommends government agencies do the work of determining eligibility so that all a former foster youth has to do is give a consenting signature. Child welfare advocates point to California as a role model, which sends a simple, one-page document asking for a signature and basic identifying information.